Chapter DHS 132

Ch. DHS 132 Note Note: Chapter H 32 as it existed on July 31, 1982 was repealed and a new chapter HFS 132 was created effective August 1, 1982. Chapter HSS 132 was renumbered chapter HFS 132 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, December, 1996, No. 492. Chapter HFS 132 was renumbered chapter DHS 132 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

subch. I of ch. DHS 132 Subchapter I — General

DHS 132.11 DHS 132.11 Statutory authority. This chapter is promulgated under the authority of ss. 49.498 (14), 49.499 (2m), 50.02, 50.03, 50.095, and 50.098, Stats., to provide conditions of licensure for nursing homes.

DHS 132.11 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; CR 06-053: am. Register August 2007 No. 620, eff. 9-1-07.

DHS 132.12 DHS 132.12 Scope. All nursing homes licensed under s. 50.03, Stats., are subject to all the provisions of this chapter, except for those provisions that apply only to particular licensure categories, and except for those nursing homes regulated by ch. DHS 134. Nursing homes include those owned and operated by the state, counties, municipalities, or other public bodies. Nursing homes are also subject to the provisions in ch. 50, Stats., and chs. SPS 361 to 365, except s. SPS 361.31 (3). Federally certified nursing homes are also subject to the provisions contained in 42 CFR 483.

DHS 132.12 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; CR 06-053: am. Register August 2007 No. 620, eff. 9-1-07; correction made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; correction made under s. 13.92 (4) (b) 7., Stats., Register January 2012 No. 673.

DHS 132.13 DHS 132.13 Definitions. In this chapter:

DHS 132.13(1) (1) “Abuse” has the meaning specified under s. DHS 13.03 (1).

DHS 132.13(1m) (1m) “Advanced practice nurse prescriber” means a person who has been granted a certificate to issue prescription orders under s. 441.16 (2), Stats.

DHS 132.13(2m) (2m) “Authorized prescriber” means a person licensed in this state to prescribe medications, treatments or rehabilitative therapies, or licensed in another state and recognized by this state as a person authorized to prescribe medications, treatments or rehabilitative therapies.

DHS 132.13(3) (3) “Department” means the Wisconsin department of health services.

DHS 132.13(4) (4) “Developmental disability” means intellectual disability or a related condition, such as cerebral palsy, epilepsy or autism, but excluding mental illness and degenerative brain disorder, which is:

DHS 132.13(4)(a) (a) Manifested before the individual reaches age 22;

DHS 132.13(4)(b) (b) Likely to continue indefinitely; and

DHS 132.13(4)(c) (c) Results in substantial functional limitations in 3 or more of the following areas of major life activity:

DHS 132.13(4)(c)1. 1. Self-care;

DHS 132.13(4)(c)2. 2. Understanding and use of language;

DHS 132.13(4)(c)3. 3. Learning;

DHS 132.13(4)(c)4. 4. Mobility;

DHS 132.13(4)(c)5. 5. Self-direction; and

DHS 132.13(4)(c)6. 6. Capacity for independent living.

DHS 132.13(5) (5) “Dietitian” means a person who is any of the following:

DHS 132.13(5)(a) (a) Certified under s. 448.78, Stats.

DHS 132.13(5)(b) (b) Licensed or certified as a dietitian in another state.

DHS 132.13(7) (7) “Facility” means a nursing home subject to the requirements of this chapter.

DHS 132.13(8) (8) “Full-time” means at least 37.5 hours each week devoted to facility business.

DHS 132.13(8m) (8m) “IMD” or “institution for mental diseases” means a facility that meets the definition of an institution for mental diseases under 42 CFR 435.1009.

DHS 132.13(8r) (8r) “Intensive skilled nursing care” means care requiring specialized nursing assessment skills and the performance of specific services and procedures that are complex because of the resident’s condition or the type or number of procedures that are necessary, including any of the following:

DHS 132.13(8r)(a) (a) Direct patient observation or monitoring or performance of complex nursing procedures by registered nurses or licensed practical nurses on a continuing basis.

DHS 132.13(8r)(b) (b) Repeated application of complex nursing procedures or services every 24 hours.

DHS 132.13(8r)(c) (c) Frequent monitoring and documentation of the resident’s condition and response to therapeutic measures.

DHS 132.13(9) (9) “Intermediate care facility” means a nursing home which is licensed by the department as an intermediate care facility to provide intermediate nursing care.

DHS 132.13(10) (10) “Intermediate nursing care” means basic care consisting of physical, emotional, social and other rehabilitative services under periodic medical supervision. This nursing care requires the skill of a registered nurse for observation and recording of reactions and symptoms, and for supervision of nursing care. Most of the residents have long-term illnesses or disabilities which may have reached a relatively stable plateau. Other residents whose conditions are stabilized may need medical and nursing services to maintain stability. Essential supportive consultant services are provided.

DHS 132.13(10m) (10m) “Involuntary administration of psychotropic medication” means any of the following:

DHS 132.13(10m)(a) (a) Placing psychotropic medication in an individual’s food or drink with knowledge that the individual protests receipt of the psychotropic medication.

DHS 132.13(10m)(b) (b) Forcibly restraining an individual to enable administration of psychotropic medication.

DHS 132.13(10m)(c) (c) Requiring an individual to take psychotropic medication as a condition of receiving privileges or benefits.

DHS 132.13(11) (11) “Licensed practical nurse” means a person licensed as a licensed practical nurse under ch. 441, Stats.

DHS 132.13(12) (12) “Limited nursing care” means simple nursing care procedures required by residents with long-term illnesses or disabilities in order to maintain stability and which can be provided safely only by or under the supervision of a person no less skilled than a licensed practical nurse who works under the direction of a registered nurse. Supervision of the physical, emotional, social and rehabilitative needs of the resident is the responsibility of the appropriate health care provider serving under the direction of a physician.

DHS 132.13(13m) (13m) “Neglect” has the meaning specified under s. DHS 13.03 (14).

DHS 132.13(16) (16) “Nurse” means a registered nurse or licensed practical nurse.

DHS 132.13(17) (17) “Nurse practitioner” means a registered professional nurse who meets the requirements of s. DHS 105.20 (1).

DHS 132.13(18) (18) “Nursing assistant” means a person who is employed primarily to provide direct care services to residents but is not registered or licensed under ch. 441, Stats.

DHS 132.13(20) (20) “Pharmacist” means a person registered as a pharmacist under ch. 450, Stats.

DHS 132.13(21) (21) “Physical therapist” means a person licensed to practice physical therapy under ch. 448, Stats.

DHS 132.13(22) (22) “Physician” means a person licensed to practice medicine or osteopathy under ch. 448, Stats.

DHS 132.13(23) (23) “Physician extender” means a person who is a physician’s assistant or a nurse practitioner acting under the general supervision and direction of a physician.

DHS 132.13(24) (24) “Physician’s assistant” means a person certified under ch. 448, Stats., to perform as a physician’s assistant.

DHS 132.13(25) (25) “Practitioner” means a physician, dentist, podiatrist or other person permitted by Wisconsin law to distribute, dispense and administer a controlled substance in the course of professional practice.

DHS 132.13(25g) (25g) “Protest” means make more than one discernible negative response, other than mere silence, to the offer of, recommendation for, or other proffering of voluntary receipt of psychotropic medication. “Protest” does not mean a discernible negative response to a proposed method of administration of the psychotropic medication.

DHS 132.13(25r) (25r) “Psychotropic medication” means a prescription drug, as defined in s. 450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior.

DHS 132.13(26) (26) “Recuperative care” means care anticipated to be provided for a period of 90 days or less for a resident whose physician has certified that he or she is convalescing or recuperating from an illness or a medical treatment.

DHS 132.13(27) (27) “Registered nurse” means a person who holds a certificate of registration as a registered nurse under ch. 441, Stats.

DHS 132.13(28) (28) “Resident” means a person cared for or treated in any facility on a 24-hour basis irrespective of how the person has been admitted to the facility.

DHS 132.13(29) (29) “Respite care” means care anticipated to be provided for a period of 28 days or less for the purpose of temporarily relieving a family member or other caregiver from his or her daily caregiving duties.

DHS 132.13(30) (30) “Short-term care” means recuperative care or respite care.

DHS 132.13(31) (31) “Skilled nursing facility” means a nursing home which is licensed by the department to provide skilled nursing services.

DHS 132.13(32) (32) 

DHS 132.13(32)(a) (a) “Skilled nursing services” means those services furnished pursuant to a physician’s orders which:

DHS 132.13(32)(a)1. 1. Require the skills of professional personnel such as registered or licensed practical nurses; and

DHS 132.13(32)(a)2. 2. Are provided either directly by or under the supervision of these personnel.

DHS 132.13(32)(b) (b) In determining whether a service is skilled, the following criteria shall be used:

DHS 132.13(32)(b)1. 1. The service would constitute a skilled service where the inherent complexity of a service prescribed for a resident is such that it can be safely and effectively performed only by or under the supervision of professional personnel;

DHS 132.13(32)(b)2. 2. The restoration potential of a resident is not the deciding factor in determining whether a service is to be considered skilled or unskilled. Even where full recovery or medical improvement is not possible, skilled care may be needed to prevent, to the extent possible, deterioration of the condition or to sustain current capacities; and

DHS 132.13(32)(b)3. 3. A service that is generally unskilled would be considered skilled where, because of special medical complications, its performance or supervision or the observation of the resident necessitates the use of skilled nursing personnel.

DHS 132.13(34) (34) “Supervision” means at least intermittent face-to-face contact between supervisor and assistant, with the supervisor instructing and overseeing the assistant, but does not require the continuous presence of the supervisor in the same building as the assistant.

DHS 132.13(35) (35) “Tour of duty” means a portion of the day during which a shift of resident care personnel are on duty.

DHS 132.13(36) (36) “Unit dose drug delivery system” means a system for the distribution of medications in which single doses of medications are individually packaged and sealed for distribution to residents.

DHS 132.13 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; emerg. renum. (3) to (24) to be (4) to (25), cr. (3), eff. 9-15-86; r. and recr. Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (8m), eff. 7-1-88; am. (4), Register, February, 1989, No. 398, eff. 3-1-89; cr. (8m), Register, October, 1989, No. 406, eff. 11-1-89; correction made to (17) under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; CR 04-053: r. and recr. (1), cr. (1m), (2m), (8r) and (13m), am. (2) and (5) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (2), (6), (13), (14), (15), (19) and (33), Register August 2007 No. 620, eff. 9-1-07; CR 07-042: cr. (10m), (25g) and (25r) Register October 2007 No. 622, eff. 11-1-07; corrections in (1), (3), (13m) and (17) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (4) (intro.) Register May 2019 No. 761, eff. 6-1-19; CR 23-046: am. (4) (intro.) Register April 2024 No. 820, eff. 5-1-24.

DHS 132.14 DHS 132.14 Licensure.

DHS 132.14(1) (1) Categories. Nursing homes shall elect one of the following categories of licensure:

DHS 132.14(1)(a) (a) Skilled nursing facility; or

DHS 132.14(1)(b) (b) Intermediate care facility.

DHS 132.14(1m) (1m) Licensure as an institution for mental diseases.

DHS 132.14(1m)(a) (a) Requirements. The department may grant a facility a license to operate as an institution for mental diseases if the following conditions are met:

DHS 132.14(1m)(a)1. 1. The conversion of all or some of the beds within the facility will result in a physically identifiable unit of the facility, which may be a ward, contiguous wards, a wing, a floor or a building, and which is separately staffed;

DHS 132.14(1m)(a)2. 2. The IMD shall have a minimum of 16 beds;

DHS 132.14(1m)(a)3. 3. The conversion of beds to or from an IMD shall not increase the total number of beds within the facility; and

DHS 132.14(1m)(a)4. 4. The facility has submitted an application under subs. (2) and (3) to convert all or a portion of its beds to an IMD and the department has determined that the facility is in substantial compliance with this chapter. A facility may not submit an application for conversion of beds to or from an IMD more than 2 times a year.

DHS 132.14(1m)(b) (b) Exclusion. An existing facility applying to be licensed in whole or part as an IMD is not subject to prior review under ch. 150, Stats.

DHS 132.14(2) (2) Application. Application for a license shall be made on a form provided by the department.

DHS 132.14 Note Note: To obtain a copy of the application form for a license to operate a nursing home, write: Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.

DHS 132.14(3) (3) Requirements for licensure.

DHS 132.14(3)(a) (a) In every application the license applicant shall provide the following information:

DHS 132.14(3)(a)1. 1. The identities of all persons or business entities having the authority, directly or indirectly, to direct or cause the direction of the management or policies of the facility;

DHS 132.14(3)(a)2. 2. The identities of all persons or business entities having any ownership interest whatsoever in the facility, whether direct or indirect, and whether the interest is in the profits, land or building, including owners of any business entity which owns any part of the land or building;

DHS 132.14(3)(a)3. 3. The identities of all creditors holding a security interest in the premises, whether land or building; and

DHS 132.14(3)(a)4. 4. In the case of a change of ownership, disclosure of any relationship or connection between the old licensee and the new licensee, and between any owner or operator of the old licensee and the owner or operator of the new licensee, whether direct or indirect.

DHS 132.14(3)(a)5. 5. Disclosure of any financial failures directly or indirectly involving any person or business entity identified in the application concerning the operation of a residential or health care facility that resulted in any debt consolidation or restructuring, insolvency proceeding or mortgage foreclosure, or in the closing of a residential or health care facility or the moving of its residents. In this subdivision “insolvency” means bankruptcies, receiverships, assignments for the benefit of creditors, and similar court-supervised proceedings.